Work related musculoskeletal disorders of the neck and upper limb.

Abstract

Work-related musculoskeletal disorders of the neck and upper limb (WRULDs) are an important concern in the workplace and a costly healthcare problem. WURLDs remain one of the most common occupational illnesses in Western countries. This thesis focuses on two important aspects of WRULDs; the first is the identification of risk factors associated with WRULDs among nurses, in particular neck, shoulder and hand or wrists pain, and their relationship with nurses’ perceived work ability, and the second is the conduct of a Cochrane systematic review to investigate interventions for the prevention of WRULDs. The first publication looks at a novel approach to identifying the risk of neck and shoulder pain in hospital-based nurses. The pain at individual sites; i.e., neck pain alone, shoulder pain alone, and neck and shoulder pain, were individually compared with those reporting no neck or shoulder pain, allowing the risk factors for the individual sites to be estimated. The second paper looks at risk factors for wrist or hand pain among nurses. Although the wrist and hand functions are important in both activities of daily living and work function, especially among nurses, the research on wrist or hand pain is limited compared to the body of research on pain in other sites of the body. The third paper investigates the relationship between multisite musculoskeletal pain and reduced work ability among nurses. Work ability is a measure of a worker’s capacity to perform their work based on the work content and job demand. The fourth and fifth papers consist of the Cochrane protocol and systematic review investigating the ergonomic design and training for the prevention of work-related musculoskeletal disorders of the upper limb and neck in adults. The first part of the thesis found that the risk factors for neck pain alone, shoulder pain alone, and neck and shoulder pain together were different. Somatisation tendency, health beliefs and mental and physical health and wellbeing were associated with neck and shoulder pain, whereas neck pain alone was more consistently associated with demographic and anthropometric factors, and shoulder pain alone with health beliefs. Wrist and hand pain was found to be prevalent in hospital nurses, and to be associated with both physical and psychosocial factors, including somatisation tendency. Musculoskeletal pain in one or more anatomical sites was found to predict reduced self-perceived work ability, with work ability reducing as the number of painful sites increased. Preventing musculoskeletal disorders among nurses should be set as a priority, and besides focusing on ergonomic factors, psychosocial factors also need to be considered in interventions. The Cochrane systematic review demonstrated moderate quality evidence that the use of an alternative mouse with an arm support board for VDU users was effective in reducing the incidence of neck/shoulder disorders but there was only low quality evidence in reducing symptoms of upper limb and neck/shoulder discomfort. There was also very low to moderate quality evidence that the other ergonomic intervention did not demonstrate any benefit in terms of preventing WRULDs. The findings have important implications for determining ergonomic interventions and education to be implemented in occupational settings in the prevention of work-related musculoskeletal disorders of the neck and upper limb.